Sexual Violence During COVID-19: Insights from an Addis Ababa Healthcare Professional

Hiwot Girma is a 26-year-old clinical pharmacist in Addis Ababa, Ethiopia. Together with Amref Health Africa, she is campaigning to end sexual and gender-based violence, particularly at a time when COVID-19 puts women and girls at even greater risk.

“My name is Hiwot. I’m a clinical pharmacist working at Ghandi Memorial Hospital as a drug information focal person. This is a specialised hospital that focuses on maternal and neonate childcare.

I also volunteer at the hospital’s sexual violence centre where I provide guidance, care and comfort for survivors of rape and sexual assault, along with medical advice.

I currently live with my brother and father because girls and women cannot leave their family household before they marry, even in the capital city. Although most people are stuck at home, I must still go out for work.”

What work do you do with Amref Heath Africa?

“I work as a youth volunteer in the AYAP (Amref Youth Advisory Parliament), which advocates for meaningful youth involvement in project implementation. I’ m also the new FGM Champion, meaning I visit other Amref projects and share information about this practice.

Fortunately, I haven’t gone through FGM because my mum and dad knew about the negative consequences. Many people still do not know about the complications. Just because I did not go through the cut, it does not mean that I should not fight for my sisters”.

How has COVID-19 affected your area, especially in terms of sexual violence?

“In Addis Ababa sexual violence largely centres around rape. In more rural areas, FGM is also performed on girls.  Lately it has been crazy in Addis Ababa – women and girls are getting raped, and the violence is increasing.

I think sexual violence during COVID-19 has risen, but the government doesn’t know the official reasons yet. Is it because everyone is at home or other factors? The Ministry of Women, Children and Youth Affairs is currently researching why the rape of women and girls is rising”.

How has COVID-19 affected you and your work with women and girls?

“At work, we have emergency triage corners set up. A nurse will take your temperature and test expecting mothers for COVID-19 when they enter. We always wear masks and gloves to give out medication, so nothing has changed there.

As I mentioned, sexual violence during COVID-19 is increasing.

My role is listening to women and girls about their experiences and the emotional impact. They are supposed to take HIV prophylaxis – a medication intended to help prevent the spread of HIV – as well as medicines to treat possible exposure to other STDs. So I also share information about those medicines and counsel them on their use”.

What motivates you to be an FGM Champion and fight against sexual violence?

“Because girls and women, I believe, should have equal opportunities. FGM is taking women and girls back – FGM causes sexual dysfunction, complications during childbirth, and things like anaemia. It also increases the risk of HIV due to exposure to unhygienic conditions.

We shouldn’t forget the medical side of it either. I heard from another medical professional that sometimes young women do not even know that they have been cut. One young woman did not know until she met a guy and decided to have a sexual relationship. Shockingly, sexual intercourse resulted in her bleeding to death. This could have been avoided.

It’s not fair that women go through these things; there’s no need. We need to make it safer for women and girls.

If we cannot protect and include women, we cannot achieve the things we want to accomplish as a country or a continent.

That is why I am passionate about participating.

We should not be afraid to fight FGM. Everyone should be responsible – whether they live in cities or the countryside. I believe everybody should say no to GBV, and everybody should come together to fight it”.

Hiwot joins four other pan-African champions in Amref Health Africa’s No More Violence: Daring to Speak Up campaign, designed to raise awareness about increasing rates of sexual violence during COVID-19.

COVID-19 is Leaving More Girls at Risk of Female Genital Mutilation and Child Marriage

The global COVID-19 pandemic is taking a particularly heavy toll on girls and young women across Africa.

Sadly, many girls in Africa are disenfranchised from birth.

They are born into poverty and vulnerable to inequalities in health and education, along with socio-economic and gender inequalities. Access to health and education is not automatic. Many girls remain marginalized throughout their lives, both geographically and economically. This exposes girls to collateral risks associated with poverty – and, at the moment, with COVID-19.

I have been lucky to be able to pursue my passion for the health and rights of women and girls for a number of years now. My work has focused on sexual and reproductive health, gender-based violence, female genital mutilation or cutting (FGM/C), and child, early and forced marriage. My experience has mainly been built by working with marginalized communities in Kenya that practice FGM/C – including the Maasai, Samburu, Kalenjins, Meru, and Somali communities.

Education Opens Horizons

In 2016, in the early years of my work in Kenya, I visited a rescue center in Samburu County. I was devastated by the reality of life for many Samburu children. Living a nomadic lifestyle in geographically vast areas, basic infrastructure to support health and education was lacking.

It took us a whole day to drive to the main town, Maralal, where the center was located. Along the road, I saw children herding cattle and goats within the national park, which is full of wild animals such as lions, elephants, giraffes, zebras, and antelopes.

The perplexing thing was that among the children were many girls, the youngest of whom looked about six years of age. Spending their days and evenings herding cattle in the woods away from home. Outside the protection of adult family members, means these girls are exposed to sexual and gender-based violence.

While visiting the center the next day, we found a newly rescued nine-year-old girl. She was rescued from forced child marriage to a seventy-year-old man who already had multiple wives. The young girl had just undergone FGM/C. Her wounds were still raw. She was brought to the center to heal and attend school, since she hadn’t previously had the chance to receive an education.

My colleagues and I were left debating how a girl will ever make it in life without an education, good health, or any future economic opportunities. For many girls in Kenya and elsewhere, their progress is curtailed and their horizons limited from childhood as a result of traditional practices which are linked to livelihoods.

Co-existing Crises Leave Girls at Risk

I can only imagine how much harder life is for girls in Samburu in the face of COVID-19. I have heard many horrific stories from my colleagues about how lockdown measures, combined with school closures and the subsequent dwindling of family resources and general livelihoods, have left more girls exposed to FGM/C and child marriage.

They are forced by their circumstances to be “sold” into marriage, either for money or cattle.

Unfortunately, in Kenya the COVID-19 crisis has also been accompanied by many natural calamities including a locust invasion, drought and flooding in many parts of the country, meaning that food is scarce.

Nomadic communities like the Samburu have been hit particularly hard. They rely on markets to sell their animals for money to satisfy their basic needs. When markets are closed, as they are currently, they cannot sell. The food crisis is likely to lead to even more girls being married in exchange for food for their families and a semblance of security.

At the same time, the focus of law enforcement in Kenya has been on stopping the spread of the coronavirus. This has resulted in many cases of gender-based violence, FGM/C and child marriage being shoved onto the back burner. As if they are not a crisis that deserves immediate attention.

Community activists working in Samburu have reported feeling powerless and hopeless. They are between a rock and a hard place, sometimes having to choose between reporting cases to the authorities and their lives being threatened.

Listening to Communities is More Important Than Ever

The Kenyan government has not embraced a multi-sectoral approach in dealing with the overall impact of COVID-19. Instead, they’ve taking a rather narrow approach to public health. Because of the focus on curbing transmission, fostering strategic engagement that includes stakeholders working in gender-based violence, FGM/C, and child marriage has been sidelined.

Including community systems in the prevention of and response to FGM/C and child marriage is more important than ever. More women and girls are now at risk of harmful practices and gender-based violence.

These strategies should include:

  • working closely with community advocates and activists,
  • working with community health workers who can play a significant role in surveillance of at-risk girls,
  • mapping them and linking them up with healthcare and legal services, and
  • setting up rescue homes and centers that could house them temporarily until the COVID-19 crisis subsides.
The majority or all of the safe centers or homes were ordered to close as part of the lockdown measures. The girls and women being housed in those centers were asked to return home in the midst of Covid-19. A doubly tragic situation for them.

So what can we do, in the face of these co-existing crises?

The greatest lesson that we can learn is that it is crucial to deliver multi-sectoral responses to FGM/C and child marriage. This means actors working together. A broader approach is needed. One that considers the wider socio-ecological aspects of livelihoods including education, health, emergencies, climate crisis and other factors which impact on the harmful practices of these communities.

State and non-state actors need to widen their nets and protect African children and girls in particular – who, as is so often the case, carry the heaviest burdens of poor health and well-being.

Dr Esho is the Director of the Amref Health Africa End-FGM/C Centre of Excellence; Secretary General, African Society for Sexual Medicine; and Associate Member, Africa Coordinating Centre for the Abandonment of FGM/C.

Do Women Benefit from Revolution?

This is the question I’ve been asking myself while reading Thomas Sankara’sWomen’s Liberation and the African Struggle’.

The book has made me think about the powerful images of Alaa Salah from Sudan. It’s also made me think about the women in South Africa – of all races and backgrounds – who marched to the Union Buildings in Pretoria in 1956, and the female members of the Black Panther Party draped in leather and berets.

I thought of all the women around the world who have taken to the streets to demand their rights, and I thought about how women have always sacrificed their time and bodies in the name of a revolution – just as men have.

“You are our mothers and life companions, our comrades in struggle, and because of this fact you should by rights assert yourselves as equal partners in the joyful victory feasts of the revolution.” – Thomas Sankara, March 8 1987

Women have long been asserting ourselves as equal partners, but are we fully indulging in the feasts of revolution?

In my own country, South Africa, I would say that the answer is no. Women have been written out of history. When I learned the history of Apartheid in school, there was zero mention of any women. Not Winnie Madikizela-Mandela. Not Albertina Sisulu. Not any of the other women who participated in the March of 1956. Not the women of the Black Consciousness Movement. I also remember learning about the Black Power Movement and hearing no mention of women like Angela Davis or Kathleen Cleaver.

Despite revolution, women still struggle for equality.

One current example is that the government in my country wants to expropriate land to the historic rightful owners. However, there is no clear plan as to how women should be included in this. We want ‘radical economic transformation’, but women are excluded from holding powerful positions. According to Africa Check, in South Africa women made up 72.5% of teachers and 37.3% of principals in public schools. The statistics in other fields are just as depressing.

Historically, the women’s rights movement has also been exclusive to middle-class white women.

This was shown by leaders of the Women’s Suffrage Movement in the United States through the exclusion of black women. Why would you exclude a group of people who undergo even more oppression than you do?

Personally, I still think the #MeToo movement has mostly benefited white women in Hollywood and middle-class white women in the West. What has changed for girls and women in countries like mine because of #MeToo? To me, it seems like nothing at all.

In some countries it is still legal to mutilate a girl’s genitalia, despite widespread acknowledgement that female genital mutilation has absolutely no health benefits for girls and women. It is a way to ‘prepare’ girls for childbearing and marriage. With this in mind, where is this ‘sexual revolution’ the Western world speaks of?

These are sad truths, but I want to call on all my sisters worldwide to take a stance together.

Let us take a stance against oppression in all forms, so that society can reap the rewards of equality. Maya Angelou said, “Each time a woman stands up for herself, she stands up for all women.” Let us be those kinds of women.

Finding My Voice & Protecting Girls from FGM/C

Most people who knew me as a child knew me as a very shy and timid little girl. Yet, today I am outspoken: I can argue with you on the subjects I feel strongly about! One of those subjects is gender equality. My passion is protecting girls and young women, in my own community and beyond, from female genital mutilation/cutting (FGM/C).

I work as a community facilitator with Amref Health Africa in Marsabit County, Kenya. The project is called Koota Injena, which means “come, let’s talk”. We work within four communities – the Borana, the Gabra, the Rendile, and the Samburu – to end FGM/C and early and forced marriage, and to redefine the value of girls.

My parents come from different communities. My mother comes from the Gabra community while my father is from the Borana. I have the most amazing parents who taught me the importance of embracing both these cultures and loving them deeply. Among the Borana and the Gabra, FGM/C is a deeply-rooted and culturally significant practice. The prevalence rate is around 98%, which tells you that almost every girl you meet will have suffered the cut.

“It’s only by talking openly that we will change things for good.”

The focus of Koota Injena, as the name suggests, is dialogue. In my community, like most African communities, it’s taboo for a young person to discuss cultural issues with clan elders. This is especially true for women and girls. Yet, I won’t give up. It’s only by talking openly with each other that we will change things for good.

No one can tell my story the way I can tell my story. That’s why I started speaking out. I decided, why not inspire people? Why not inspire young girls from villages deep in Marsabit County and make sure that they know the importance of education and that they know their rights.

Listening and Learning

All kinds of people cut their daughters, even political leaders, professors, and doctors. In Marsabit, we have women traveling from other countries (the UK, the Netherlands, the USA) to have their daughters cut, before returning home. Many of these people are highly educated. Yet they continue to believe that FGM/C is the right thing to do for their daughters.

That’s why I always say that it’s not just a question of education. It’s important to change mindsets and attitudes, too. I really believe that the work of changing culture can best be done by people from that culture. You have to meet people where they are. There is no one approach that works for all the different countries and communities where FGM/C is practised. We must listen and learn. And we need to make space for different perspectives and different voices.

Safe Spaces

In late 2019, I came to London for the first time and met local activists working to end FGM/C in the UK. I attended a workshop facilitated by Sarian Karim-Kamara, founder of the Keep the Drums, Lose the Knife collective, which brought together women from Sierra Leone, Kenya, and Guinea. Some were survivors of FGM/C, while some had been affected in other ways. They had friends or family members who had suffered the consequences of the cut or daughters they were trying to protect.

It was amazing to see these women, who didn’t know each other, speak so openly. They spoke not just about FGM/C, but about gender-based violence, relationships, family planning, reproductive health, and sex and pleasure. It was very emotional.

This is the same kind of safe space that we try to create in Marsabit. We have mother-daughter forums where women can talk about whatever affects them in their day-to-day lives. This is actually the most impactful part of the project: it’s the part people always ask for more of.

“You cannot force change.”

Meeting with these women reinforced to me the importance of understanding and respecting a culture before we try to change it. We all need to recognise that there are aspects of our cultures that are harmful to girls – but you cannot force change. 

Changing culture takes a lot of time. And people are not very receptive: first you’ll be insulted, you’ll be called names, and people won’t even come to your meetings. But as you keep talking with them, people will slowly come to you and they will want to speak out and tell their own stories.

If we are going to end FGM/C, we all need to take responsibility: start from your home and make sure you protect your daughters, nieces and sisters from this harmful act. We need more people to join us on the journey. Together, let’s end FGM/C!

Diram Duba is a survivor of FGM/C who works as a community facilitator with Amref Health Africa in Marsabit County, Kenya.

All Teachers Need Mandatory Training on FGM

Written by Katrina Lambert (18) and Caitlin Moore (18) – Youth For Change UK members

Ever felt like decision makers aren’t listening to young people? That our voices are ignored and belittled in society? We certainly do sometimes. And we’ve decided to make some noise about it.

We are members of Youth for Change, a global network of youth activists who aim to tackle gender-based violence.

The best way to create positive change is through young people working together to make a difference. We are the ones affected – we should be the ones influencing policy.

Over the last few years we have been tackling the issue of Female Genital Mutilation (FGM). FGM is a form of violence against girls. It can result in a lifetime of pain, psychological problems and difficulty in childbirth.

Around 125 million girls have been cut worldwide. An estimated 137,000 girls and women live with FGM in the UK.

In 2017, our research found that 90% of young people surveyed said that learning about FGM as part of Relationship and Sex Education (RSE) would help to protect and empower them and their peers. This was the focus of our campaign to get FGM in the RSE curriculum.

Therefore, we were incredibly excited when it was announced that Relationship and Sex Education (RSE) would be compulsory in every school in England as of 2020. Education plays an absolutely crucial role in young people’s lives (as two school students, we can verify this 100%).

Having FGM taught in schools is our chance to take a step forward in ending this harmful practice.

At Youth for Change, when the Department for Education released the online curriculum consultations, we engaged with our networks and communities to strengthen the voice advocating for FGM to be included.

We fed this back to the Department for Education when a group of us met with senior civil servants last year. We also met with Carolyn Harris MP, Shadow Minister for Women and Equalities, to discuss the importance of empowering young people through educating them on FGM.

As a result, questions about FGM being a priority area of the new curriculum were raised in Parliamentary Questions, to the then Home Secretary, Amber Rudd MP.

In February 2019, it was celebrations all round. We heard that FGM was to be included as a topic in the curriculum. However, as tempting as it may be, we can’t stop now and pat ourselves on the back.

Yes, we have taken a monumental step in the direction towards eradicating FGM. However, in order to ensure that the new curriculum can appropriately educate and empower young people on the issue, teachers must feel equipped.

This is why Youth for Change is calling for mandatory training for all teachers on FGM.

Our research shows that 94% of young people feel school staff don’t know enough about FGM. If there is any chance of the the new curriculum guidance achieving its fullest positive impact, teachers must be trained.

When students are aware of the issue and feel confident that their teachers understand it, then they will naturally feel more protected and comfortable in opening up conversations. This is essential in increasing reporting and saving the lives of thousands of young women and girls across the UK.

Mandatory training for teachers will ensure that every pupil in the UK gets equal access to the FGM education they deserve, regardless of what part of the country they happen to be educated in.

The benefits of training teachers in FGM are not limited to students. It will also empower teachers to feel equipped to take on their role.

In fully understanding their legal responsibilities, including mandatory reporting, teachers will able to confidently safeguard their students and signpost the correct support. Training is absolutely essential. Without it, the huge changes to the curriculum will not be able to support and educate young people.

What can you do?

Get involved with us as we continue to press for standardised, mandatory training for teachers on FGM! Find us on twitter @YouthForChange. And while you’re here, support all of the other amazing activists in our network, such as IKWRO, who are calling for FGM to be tackled earlier on in education.

We’re not going to stop making noise. We need to ensure that the education young people receive reflects what they want and need to learn. We very much hope that the Government will listen to our calls to introduce mandatory training. Together, we can move even closer to eradicating FGM in the UK once and for all.

Like this post? Try these…

Politics Affects our Health: the Case of Sudan

‘Social determinants of health’ are the circumstances and surroundings that influence an individual’s health outcomes.

Researchers have focused on social determinants of health for decades and there is now a general consensus that higher socioeconomic status predicts better odds of future health and well-being. While this notion is scientifically accepted, it prompts the question: what creates these social determinants of health? This has brought much needed attention to the ways in which politics affect health – both directly and indirectly.

‘Political determinants of health’ are the factors that shape the social determinants of health. This is a relatively new concept and is of particular significance for women. An example of the link between politics and health can be found in Sudan.

In Sudan, the political climate is shaped by religion and the constitution is based on teachings of Sharia Law. Currently, many communities face extreme financial strain as a result of failed past politics and/or war and insecurity. This has increased pre-existing and vast social inequities, including gaps in financial and educational opportunities.

The political situation in Sudan has had inevitable consequences for health.

Social disadvantage falls heavier on women. Until recently, girls have been denied the same education as their male counterparts. Lack of education leads to limited knowledge of health, which affects an individual’s ability to improve their own health outcomes. 

One example is the issue of sexual and reproductive health. Sexuality and sexual behaviour are sensitive topics rarely discussed in conservative, religious cultures like Sudan’s. Sexual and reproductive health and rights do not enjoy a high-priority status among political agendas, either, and there has been very little consideration of introducing sexual education into classrooms. However, many educators and health officials have started to support sex education in schools, resulting in increasing support by legislators.

Another example is the high prevalence of female genital mutilation (FGM) in Sudan, at a prevalence of approximately 89% countrywide. The harmful practice continues to affect many areas of the country, and although it is legally banned, it is well-known to continue with the open support of many religious leaders. This is a clear example of failed implementation of legislation that has allowed FGM to remain prevalent despite wide-spread efforts by campaigns and NGO peer-education programs.

Under Sudanese constitution, child marriage, forced marriage or marital rape are not against the law.

Much of the country’s legislation does not provide any protection for women’s rights. As a result, many Sudanese women fear persecution.

One case that struck the international community was that of Noura Hussein in 2018. The 19-year-old was sentenced to death for fatally stabbing her husband – who she had allegedly been forced to marry – after he attempted to rape her. In the eyes of the law, marital rape does not exist, and so Hussein had no claims to self-defence as she was viewed as a belonging of her husband. The ruling was thankfully overturned after increasing international pressure on the Sudanese government. Hussein received a reduced sentence of 5 years in prison. 

Historically, women in Sudan have been forced to be subordinate to men. Although this is changing and vast improvements have been made, drastic changes to the country’s politics and constitution are needed to ensure full protection of women’s rights – especially their rights to health and wellbeing.